Many people who are living with wet age-related macular degeneration (AMD) have questions about the different treatments that are available to them. In particular, people wonder about how Lucentis, Eylea and Avastin differ. These three drugs are all anti-VEGF agents that are injected periodically into the affected eye.
What is an ‘anti-VEGF’ agent? Vascular endothelial growth factor (VEGF) is one of a family of substances, normally produced by our bodies, that tell new blood vessels to form. This process is especially important for wounds to be able to heal. However, VEGF can also cause the growth of new blood vessels where they are not needed, and this may be detrimental to health. For example, the uncontrolled growth of blood vessels in the eye is what causes vision loss in wet AMD. Anti-VEGF agents stop unwanted new blood vessels from growing, by removing or inactivating VEGF; thus, these drugs can prevent vision loss in wet AMD.
Lucentis (ranibizumab), which was approved to treat wet AMD in 2007, can stabilize vision loss – and, in some cases, restore vision. In 2013, Eylea (aflibercept) was approved to treat wet AMD in Canada. Although Eylea and Lucentis act similarly to get rid of VEGF proper, Eylea has the additional effect of removing a related substance – Placental Growth Factor (PIGF) – which also causes the growth of new blood vessels. Eylea is slightly cheaper than Lucentis, and some studies show that patients can wait a longer time between Eylea injections. Some ophthalmologists will use Avastin (bevacizumab) – an anti-cancer drug – to treat wet AMD, because it works just like Lucentis but is significantly more affordable. Although Avastin is not approved by Health Canada as treatment for wet AMD (Health Canada issued a statement to warn against the using Avastin in the eye in 2011, which you can read here), it is commonly used off-label because its efficacy and safety have been established in research studies. However, there are also studies that question the saftey of Avastin, such as this Canadian study, which we shared on our website a number of years ago). Because of this range of evidence, doctors are continuing to discuss the pros and cons of using these different drugs. The question remains open, partly because many doctors will begin a course of treatment with one drug and then switch to an alternative drug if/when the first one stops working. This is also why the Foundation Fighting Blindness is funding research to find better AMD treatments.
How do you work with your doctor to decide what is best for you? You can start by learning the basics of the available treatment options, from reliable sources such as this article and the websites of governmental and charitable health organizations. You can also learn about AMD treatments by listening to Dr. Varun Chaudhary’s Vision Quest talk, or other AMD-focused sessions from our Vision Quest educational series. Then you can ask for your doctor’s advice about the different drug options – what are the benefits and risks of each, and what evidence supports the doctor’s recommendation – and inquire about what treatments and costs are covered in your province and by your drug plan.
At the Foundation Fighting Blindness, we understand that making these kinds of decisions can be difficult, especially if some of the more expensive drugs are not covered by your province or insurer. We are working to advocate for better drug access to improve your vision health. Are you having trouble accessing the drugs that you need? We want to hear your stories. You have the power to make a difference.
Please speak to your doctor about the best treatment option for you.